title: The effect of revascularization procedures on healing of mixed arterial and venous leg ulcers.
abstract: OBJECTIVE
  The optimal management of venous leg ulcers in patients with concomitant peripheral artery disease (PAD) remains unclear. The aim of the present study was to evaluate the effectiveness of revascularization procedures in healing of the ulcers of mixed etiology.
  
  
  METHODS
  During a 6-year period a total of 20 patients with evidence of chronic venous insufficiency, impaired arterial perfusion (ABI<0.75) and active leg ulcer were treated. Patients with moderate PAD (0.5<ABI<0.75) were treated conservatively with modified compression and were considered for revascularization if the ulcer did not heal, while those with severe PAD (ABI<0.5) underwent revascularization.
  
  
  RESULTS
  Eleven out of seventeen (64.7%) limbs with moderate arterial disease showed a significant healing progress after modified compression and healed at an average time of 24.7±3.1 weeks, while the other 6 limbs (35.3%) failed to improve underwent revascularization and healed at an average time of 16±2.6 weeks. Three limbs with severe arterial disease underwent revascularization and healed at an average time of 17.6±2.5 weeks. Overall the nine arterial interventions had a 100% technical success rate, while ABI improved from 0.54±0.07 to 0.94±0.04 after the intervention. The 30-day mortality was null. Healing time in patients treated with revascularization was significantly lower compared to those treated conservatively (16.6±2.6 weeks vs. 24.7±3.2 weeks, P<0.001). During the follow-up period (48.7±14.3 months), there were 9 ulcer recurrences, 6 in the group of conservative treatment and 3 in the group of revascularization. No significant difference in recurrences between the two groups (log rank=0.772, P=0.38) was demonstrated.
  
  
  CONCLUSIONS
  A protocol-driven therapeutic strategy that includes a revascularization procedure as a therapeutic option in patients with ulcers of mixed etiology may be beneficial. Based on the current data, it is essential the therapeutic strategy to be individualized by including an overall risk assessment accounting for comorbidities of the patient and the risk of the procedure.
authors.affiliation: Unit of Vascular Surgery, 1st Department of Surgery, University of Athens, Medical School, Athens, Greece. geokouv@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Georgopoulos
authors.forename: G N
authors.initials: GN
authors.lastname: Kouvelos
authors.forename: A
authors.initials: A
authors.lastname: Koutsoumpelis
authors.forename: C
authors.initials: C
authors.lastname: Bakoyiannis
authors.forename: M
authors.initials: M
authors.lastname: Lymperi
authors.forename: C
authors.initials: C
authors.lastname: Klonaris
authors.forename: C
authors.initials: C
authors.lastname: Tsigris
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D055109:Ankle Brachial Index; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007871:Leg Ulcer / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D053828:Stockings, Compression; D013997:Time Factors; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D014945:Wound Healing